College Bridge Program Registration - Harrisville

If you see this don't fill out this input box.

Student First Name*Student First Name

Student Last Name*Student Last Name

Student Middle Initial*Student Middle Initial

SSN*SSN

Home Address*Home Address

Home City*Home City

Home State*Home State

Home Zip Code*Home Zip Code

County of Residence* Please Select Essex Franklin Hamilton St. Lawrence Lewis Clinton Warren WashingtonCounty of Residence

Date of Birth*Date of Birth

High School Level

Junior

Senior

High School Level

Home High School*Home High School

College Bridge Program Location*College Bridge Program Location

Family Telephone Number*Family Telephone Number

Student Email Address*Student Email Address

Gender

Female

Male

Other/Non-Binary

Gender

Citizenship

I am a US Citizen

I am not a US Citizen

I am an international student

Citizenship

Ethnicity (optional) Please Select American Indian/Alaskan Native Native Hawaiian/Pacific Islander Asian White Black/African American Hispanic Two or More RacesEthnicity (optional)

Location Courses

SPA 101--- Intro to Spanish--- A. Oxenford--- M-F--- Full Year---10:09-10:49

ENG 101 EHV--- Eng Composition--- K. Reed--- M-F--- Full Year--- 12:05-12:45

ENG 101 EHV1--- Eng Composition--- M. Fuller--- M-F--- Full Year--- 12:48-1:28

MAT 132 EHV--- Pre-Calculus--- S. Carr--- M-F--- Full Year--- 9:26-10:06

HIS 104 EHV---World History II---D. Price---M-F---Full Year---10:52-11:32

HIS 151 EHV--- US History I--- D. Giver--- M-F--- Fall--- 7:55 - 8:40

HIS 152 EHV--- US History II--- D. Giver--- M-F--- Spring--- 7:55 - 8:40

Please check the boxes of the classes you will be taking for college credit this year:

Signature

I understand that by signing this registration form I am formally enrolling in courses offered by North Country Community College at my high school. I have indicated my choice on the form below. I understand that New York State Education Law allows me to enroll in these courses without a signature from my parent or guardian.

I am responsible for paying $75 for each course I select below. I understand that I will receive a green bill at my mailing address which I will have to pay unless I formally drop these courses before October 28 2023. I can inform my instructor and/or guidance counselor prior to that date. If I do not I will still have to pay for the course even if I choose not to participate at a date after October 28 2023.

I further understand that I will need to provide my social security number to facilitate official enrollment receipt of transcripts and reporting processes as established under Section 355 of the Education law of the State of New York. If I do not provide my social security number by October 28 2023 I will be removed from the program without notice. Signature

Signature

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